Adequacy of pain management in HIV-positive patients

Abstract

S Afr Fam Pract 2011;53(1):71-76Background: A growing body of literature supports the view that people infected with HIV suffer significant pain and that pain is not well recognised or managed by health care professionals. This study investigated the prevalence, severity, recognition and management of pain in adult patients with HIV infection in a South African hospital setting. Methods:The Brief Pain Inventory (BPI) (short form) questionnaire was administered to 100 consecutive, consenting HIVpositive patients admitted to an urban district-level hospital in KwaZulu-Natal. Convenience sampling was employed with participants recruited on consecutive days. Data sources comprised patient interviews and review of hospital records. A Pain Management Index derived from the BPI was calculated to establish the adequacy of pain management. Descriptive statistics were tabulated for the recognition of pain, pain severity and appropriateness of analgesia. Correlation analyses were used to assess the association between pain and daily life.Results: Ninety-one per cent of participants reported pain with 83% experiencing significant pain, in other words a "worst pain" rating of five or above on the BPI (short form) questionnaire. The correlation analysis between the severity of pain and its interference with daily life suggests that moderate and severe pain interferes with the patients' daily functioning. Pain was documented on 71% of the patients' medical charts that were reviewed; however, only 34% were considered to be adequately managed for their pain. Conclusion:Pain prevalence is high in the sample. While pain was recognised and noted in the majority of patients' medical records, the management of pain was considered to be inadequate in a third of those experiencing pain.Peer reviewed.

Pain in ambulatory HIV‐positive South Africans

“…Our participants were ambulatory outpatients, though, and not in the advanced stage of disease of the participants in the studies by Norval () and Narasimooloo et al. (), who both reported pain prevalence of greater than 90%. We also did not have CD4 T‐cell counts for all our participants.…”

“…Indeed, studies on quality of life in African HIV-positive populations have shown that pain is a frequent complaint of infected individuals (Hughes et al, 2004;Shawn et al, 2005;Uwimana and Struthers, 2007;Voss et al, 2007;Peltzer and Phaswana-Mafuya, 2008;Rosen et al, 2008), with pain prevalence being over 90% in patients with advanced disease (Norval, 2004;Narasimooloo et al, 2011). Management of pain also was poor in hospitalized patients and those with chronic pain (Maree et al, 2011;Narasimooloo et al, 2011). Yet, no studies have thoroughly investigated the characteristics of pain and its treatment in HIV-positive people living in sub-Saharan Africa, and the risk factors for having pain (Kamerman and Mitchell, 2011).…”

“What is Killing Me Most”: Chronic Pain and the Need for Palliative Care in the Eastern Cape, South Africa

“…21 A survey of HIV end-of-life programs in sub-Saharan Africa found that 94% of programs reported problems with pain relief, including drug availability and government restrictions. 22 Patient self-reports [23][24][25] and analyses of pain medication prescribed 26 have also found that pain in patients with HIV is inadequately managed. Moreover, in a system of limited resources, priority is often given to curative treatment.…”

Clinical practice guidelines for management of neuropathic pain: Expert panel recommendations for South Africa

“…53 A recent study conducted in a South African hospital revealed that although 71% of the patients with HIV/AIDS had pain documented in their medical charts, only 34% of the patients reported adequate pain management. 54 HIV-positive outpatients are no better off, with over 40% of ambulatory patients in pain not receiving any treatment, and of those patients who received treatment, less than 3% received drugs recommended for the treatment of NeuP, despite over a third of the patients having symptoms consistent with HIV-SN. 55 These studies highlight that the neuropathic component of HIV-related pain is probably poorly recognised and undertreated in South Africa.…”